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General NPI Number Information
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NPI Number | 1316370075
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Entity Type | Organization
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Legal Business Name | BRAINTREE FAMILY DENTAL
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 381 WASHINGTON ST
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City | BRAINTREE
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State | MA
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Zip | 02184-4741
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Country | US
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Telephone | 781-843-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 381 WASHINGTON ST
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City | BRAINTREE
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State | MA
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Zip | 02184-4741
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Country | US
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Telephone | 781-843-0340
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT, BOARD OF DIRECTOR
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Name | DR. HUY NHU PHAM
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Credential | PHARMD
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Telephone | 617-750-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | MA
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